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Ventilation and Weaning

Contents

Introduction

Ventilation can be defined as the process of exchange of air between the lungs and the ambient air[1]. In the clinical setting, a machine known as a mechanical ventilator is used to perform this function on patients faced with serious respiratory illness. Weaning is the gradual withdrawal of a patient from dependency on a life-support system or other form of therapy[2]. Weaning a patient from a ventilator occurs when the condition of the patient improves and a decision is made to remove them from the ventilator through a trial of spontaneous breathing through the endotracheal tube and eventually extubation (removal of the tube).

Procedure

The procedure is as follows:

Explanation of the procedure to the patient, assuring them it is only for a trial period

The ventilator support is gradually reduced (e.g. reducing pressure during pressure support)

The patient is placed into a better postural position (e.g. sitting upright or half-sitting)

The airway is suctioned

The patient is disconnected from the ventilator and given oxygen or mechanical assistance (CPAP)

The patient is encouraged to breathe spontaneously

The patient is monitored for signs of laboured breathing, anxiety or an increase in PaCO2

Extubation should occur as soon as possible because breathing through an endotracheal tube increases the work of breathing

Encourage the patient to cough after being extubated

Patients may be extubated when they are alert, show a stable breathing pattern and control their airway. Difficulties in weaning patients from a ventilator can occur due to:

Inspiratory muscle atrophy

Fatigue

Paralysis of the diaphragm

A fear of suffocating

Guidelines

The following are links to documents that serves as clinical guidelines to the use of mechanical ventilator and when to commence weaning process;

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